Evidence of meeting #141 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was community.
A recording is available from Parliament.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Clearly, Dr. Vogel, these patients would have more than just a prescription or free and very potent opioids. They would have access to therapy, housing and other supports, as you mentioned previously.
Chief physician, Division of Substance Use Disorder, University of Basel Psychiatric Clinics, As an Individual
I would say that it's a spectrum of therapy that is available, and on the very basic end of opioid agonist therapy is the provision of medication, but as I pointed out, I think a lot more has to be offered in this therapy, like you said, housing, but also psychiatric treatment, treatment of concurrent psychiatric disorders and other options.
I want to make clear. I know that you're a physician, right? You're a general physician.
Chief physician, Division of Substance Use Disorder, University of Basel Psychiatric Clinics, As an Individual
A lot of the treatments here are done by general physicians, but those are the more stable patients. They have a long and ongoing relationship with their GP. That works fine. You can do take-home for most of them. It will work fine.
We also have specialized institutions that are responsible for, let's say, the patients with more problems, with the psychiatric problems and with comorbidities. We also have a large scale of these institutions that treat about 45% of patients. The rest are treated in GP practices.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thank you very much, Dr. Vogel.
I think it's important out there that Canadians understand that those treatment beds and those other supports do not exist in Canada. I think the other important point is, that, as I said, simply giving people who are actively struggling with addiction Dilaudid eight-milligram tablets—30 of those at a time—realistically amounts to palliative care: “Please go out and use those as you wish or sell them in a diversion manner.” We also know that that's not terribly helpful.
Certainly, the model you're talking about, in the parlance here in Canada historically with methadone, we would understand that people develop a therapeutic relationship with practitioners and then have that ability for, as we call it here, “carries” or take-home doses, when they become more stable in their addiction and have that therapeutic relationship.
I think one of the other things—and certainly I know you'll correct me if I'm wrong—is that fentanyl has not been a significant problem in Europe. Is that a true statement, Dr. Vogel?
Chief physician, Division of Substance Use Disorder, University of Basel Psychiatric Clinics, As an Individual
I wouldn't say for all of Europe. There are countries where it's a problem.
In Switzerland, it hasn't been a problem yet. We have nitazenes just arriving on the scene, which are similarly potent to fentanyl or more potent. We will have to adjust our treatment.
This is what I pointed out in my last comment. I think that where there's no evidence, you have to collect evidence. This is something that the Swiss did as well. They did a large study on heroin-assisted treatment, which showed that it worked and was cost-effective.
This is probably something that we would do if the nitazenes arrive on a larger scale. It's that we would start treating with higher potency opioids like fentanyl, because we know that methadone is not a good medication for many patients, and patients need to be able to choose from a variety of available substances. Heroin—pharmaceutical heroin—is among them and it's very strong. You can inject it, but for patients with fentanyl use, maybe even this is not enough and we have to provide fentanyl for these patients in the context of a treatment.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Vogel.
Thank you, Dr. Ellis.
Next, we have Ms. Sidhu for five minutes.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you, Mr. Chair.
Thank you to all of the witnesses.
I offer my sincere condolences to you, Mr. and Ms. Hedican, on the loss of your son.
My first question is for you.
Can you talk about the stigma around those struggling with addiction? What kinds of programs do you think could be run that are designed around awareness? Then, if someone has a problem, how can they use the pathway of harm reduction?
As an Individual
First, I'll say that, as long as the words “illegal” and “criminal” are tied to substance use and addiction, we will always have stigma. It can never be removed.
We need to start educating our kids better about the harms of substance use and to start acknowledging that the gateway drug, alcohol, opens that path. As a recovering alcoholic, I never would have tried cocaine if I hadn't been drunk out of my mind. All of my friends who did hard drugs were drunk first. However, we don't acknowledge alcohol as the gateway drug.
Go ahead, sweetie.
As an Individual
I wish I had written down the question.
Can you ask it again, please, Sonia?
Liberal
Sonia Sidhu Liberal Brampton South, ON
It was about stigma. Also, how can we raise awareness before they use a drug? Do you think it should be done in the schools and maybe in social organizations? What needs to be done?
As an Individual
There are two things I'm very passionate about.
I believe there has not been enough research looking into neurobiological components and treatment methods. Research for addiction has been very low. As we said in our speech, the model for AA is based on “just don't use”. However, we would never say to anybody who has cancer or diabetes, “Just don't eat the sugar. Then you won't have a problem.” We look at all the different ways. I would say that research really needs to be improved.
We have shared Ryan's story in a PowerPoint with schools, nurses and all sorts of people so they understand it's not a choice. It's about educating people and reducing the stigma over consuming a substance. It does not mean you are a bad person. People who smoke cigarettes are addicted. Nicotine is highly addictive. Some treatment methods are medical, but nobody ever—now—shames people who smoke. If we can present it from a medical perspective with the neurobiological components of what's happening, and let people know that substance use is a normal thing that happens....
How do you have a healthy relationship with yourself? How do you acknowledge that your consumption of whatever you choose is not healthy, then understand where to go to get help? Our doctor was not able to provide help to Ryan when he needed it, so it's not just about educating users. It's also the education of people who provide support so they understand people don't choose to be addicted.
However, I also want to say that I feel the media portrays people who use substances as causing difficulties, since they are very visible right now when unhoused. That's not the math. That's not the vast majority of substance users. Those users cannot support the billion-dollar industry that organized crime has. There are so many other substance users, and we don't acknowledge that.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you, Ms. Hedican. I'm sorry. I have to go to Chief Truong.
Chief Truong, you talked about collaboration among health services, social services and public safety as a pathway to care for individuals with substance dependence. You emphasized the need for resources to attract people to treatment.
How many arrests do the police make for public drug use?
Chief of Police, London Police Service
Chair, through you, I can tell you that in our jurisdiction the charge of possession of a controlled substance for the last few years has whittled down to nearly a fraction of what previous years have seen. Although we haven't decriminalized the possession of controlled substances, specifically individuals using open spaces, by not engaging, not arresting and not engaging when appropriate, we have seen a de facto decriminalization of possession of a controlled substance.
We see the impact that is having in our community right now in London. If we don't address it, then we're causing some serious harm and it's impacting businesses, communities and the greater community as a whole.
Ma'am, you're citing comments that I've made in the community before our police service board and before city council. I will just reaffirm to you that we've listened to the community and it's about balance. We need to ensure that we have balance. When appropriate to do so, especially in the context of impacting the greater community as a whole, police officers have to have the ability to engage. We're looking at engaging in an effective way with our community.
Liberal
The Chair Liberal Sean Casey
Thank you. We're well past time.
Mr. Thériault, you have the floor for two and a half minutes.
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
I have a question for Ms. Brière‑Charest, but before I get to that, I'd like to pick up on something I just heard from Chief Truong that's bothering me.
Mr. Truong, you answered a question earlier about decriminalization. You're a law enforcement expert, so I'm assuming that you're not confusing legalization, decriminalization and diversion. However, you said that, when people use drugs in an inappropriate place, there's no municipal bylaw that allows you to intervene, because of decriminalization. However, decriminalization is only about simple possession. It means a person won't be taken to the police station and put through the judicial process. That doesn't stop you from enforcing the basic rules of order in your city.
Don't you have that power, contrary to what you just said?
Chief of Police, London Police Service
Thank you for the question, sir.
Chair, through you, I missed some of that translation. I apologize, sir.
If I understand you correctly, what I actually said was that in Ontario and in London, it is still illegal to possess and use controlled substances in our community. However, by de facto, our police service has not been engaging individuals who are using in open spaces because we have taken a position of compassion. We've taken a position with the principles of the changes in the Controlled Drugs and Substances Act where officers are looking at alternatives to arrest.
Bloc
Luc Thériault Bloc Montcalm, QC
I understand that, but I want to clarify one thing.
You're implementing a kind of diversion, but I don't understand why a police chief can't tell his officers that they have to intervene when someone breaks the basic rules of order in a city. It has nothing to do with diversion, decriminalization or compassion. It is strictly a matter of respect and decorum that everyone must exhibit in a public place. If I drink a bottle of champagne and smoke a pack of cigarettes outside the entrance to a hospital, the police or security services will intervene. It has nothing to do with the issue before us.
Why don't police officers intervene to enforce the basic rules of order when they see problems involving people struggling with addiction? You have that power. Why aren't you using it in cities?
Liberal
Chief of Police, London Police Service
That's not what I'm saying, sir. What I'm saying is, as in previous years, our officers have not been engaging and they've been taking a compassionate approach. What I've stated publicly is that we've listened to the community.
It is still illegal to use controlled substances in public, and we are looking to enforce our position of arrest when appropriate.
Liberal
NDP
Gord Johns NDP Courtenay—Alberni, BC
I'm going back to Mr. and Mrs. Hedican.
Can you speak about your advocacy for evidence-informed policy approaches to the toxic drug crisis and what motivates you to speak out about this increasingly politicalized issue?
I'm going to add a second question here because I have only two and a half minutes. I'll give you time to respond.
Has witnessing the incremental approach that all levels of government have taken and the increasing politicization of the toxic drug crisis made your grief journey even more challenging?
As an Individual
That question gets bigger with each day because there isn't anybody here talking about the people who aren't addicted. There are kids who are dying. It's like they don't exist. It's the people who aren't ever going to go to recovery who are dying and don't exist to you. I don't understand how you can ignore these lives that are being lost in the thousands and will continue to be lost. It's like they don't exist to you.
You're failing in your responsibility to protect all Canadians. It's a gut punch every day to know there are five to seven in B.C. and 22 in our country. You're not dealing with the majority of them. You're not acknowledging it. It's a gut punch.
Our government is failing in its responsibility. We need to quit talking about atrocities in other countries because there's one in our goddamn country. There are 22 people who are going to die today, and the majority of them are not addicted. They're not talking about safe supply, and you're not acknowledging it.
Until we deal with the toxic drugs supplied by organized crime, you're failing in your responsibility to protect all Canadians. Do your jobs.
As an Individual
I don't know if this would be the time, but I actually wonder if Dr. Vogel had a toxic drug supply problem when they implemented their policies.